Understanding adolescent girls’ experiences with accessing and using contraceptives in Zambia – BMC Public Health

Sustainable Development Goals and Adolescent Contraceptive Use

Results from this study revealed that adolescents’ experiences concerning contraceptive use across the continuum of care is influenced by various factors such as, experience with knowledge of contraceptives, including sources of information about contraceptives; experience with contraceptives accessing contraceptives, including the various challenges that come with this; experience with using contraceptives including misconceptions about contraceptives; and given these experiences, their preferred types of contraceptives.

Experience with information on contraceptives

Knowledge of contraceptives

Participants were aware of and understood what contraceptives were. When asked what they understood by contraceptives, they described contraceptives as methods of preventing pregnancy and a means of planning for children.

“When I just hear the word family planning, the first thing that comes to mind is a person wanting time to decide when to have a child.“ [FGD 6, participant 3, Location Urban Clinic, Kasama].

“It’s a way of preventing unwanted pregnancies. You are not ready to get pregnant, but you want to have sex.“ [FGD 1, participant 5, Location Urban Clinic, Kasama].

“Methods of preventing pregnancies as one waits for the right time to get pregnant.“ [FGD 5, participant 4, Chikoyi Clinic, Luwingu].

Beyond just knowing what contraceptives were, participants were also knowledgeable and aware of the different methods, such as pills, IUDs, injectables and condoms, that they could use.

“We can use pills, female condoms, injectables.“ [FGD 5, participant 4, Chikoyi Clinic, Luwingu].

“There is another one whose name I can’t remember……… Yes! Microgynon pill.“ [FGD 1, participant 6, Location Urban Clinic, Kasama].

Regarding emergency contraceptive pills, one participant had this to say.

“If I have unprotected sex with my boyfriend, I need to take it immediately or within 72 hours.“ [FGD 6, participant 7, Location Urban Clinic, Kasama].

Sources of information on contraceptives

The research participants had different sources from which they got their information on contraceptives. Some of the primary sources of information were health facilities, specifically clinics and youth-friendly spaces, friends, and through the media such as television, radio and the internet.

“Health facilities, we get information on Depo from mother to child health care. They explain to us how it works.“ [FGD 1, participant 2, Chongwe Clinic, Chongwe].

“From the youth-friendly corner, I see a lot of people come to get contraceptives. They are usually sensitised and given information about the contraceptives before they choose which one they want.“ [FGD 6, participant 1, Location Urban Clinic, Kasama].

“There are adolescent programs, for example, on Lutanda radio station or Mano, they do bring people to sensitise on contraceptives. For example, every Friday, there is a program where they speak about such.“ [FGD 6, participant 7, Location Urban Clinic, Kasama].

“It was on the morning after pill. My friend told me that after having sex, you need to use it within three days after having sex.“ [FGD 6, participant 2, Location Urban Clinic, Kasama].

Other sources of contraceptive information included parents, relatives, partners, non-governmental organisations (NGOs), and schools. However, with parents, information was provided mainly to adolescents who already had children to deter them from having more children.

“With parents, unless they see that you have exceeded having children [had a lot of children], that is when they will tell you to go for family planning.“ [IDI 1, participant, Mtendere Clinic, Lusaka].

There were mixed sentiments about the contraceptive information provided in schools. Information provided through established curricula, such as comprehensive sexual education and subjects like science and some clubs, was largely viewed as positive, while teachers’ opinions on contraceptives were seen as judgemental.

“From school through JETS club. They teach about different topics [on contraceptives].“ [FGD 2, participant 5, Chongwe Clinic, Chongwe].

“At school, from the teachers in subjects like science [they address contraceptives].“ [FGD 5, participant 4, Chikoyi Clinic, Luwingu].

However, participants raised concerns about teachers’ judgemental and anti-sex attitudes towards the girls who use contraceptives. As one participant mentioned,

“In schools, teachers are so judgemental. Each time you ask about contraceptives, they start saying things like, “At your age, you have started having sex”. This makes pupils uncomfortable to approach teachers to get information on contraceptives. That is why most of them chose to go to the clinic.“ [FGD 7, participant 2, Namalundu Clinic, Kasama].

Participants also raised concerns about the lack of a conducive environment in schools, hindering them from freely approaching teachers for information. Teachers’ inability to maintain confidentiality when adolescents sought information on contraceptives and often using this against them by discussing their sexual activity in class was another deterrent.

“At Kasama Secondary [

SDGs, Targets, and Indicators

SDG 3: Good Health and Well-being

• Target 3.7: By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programs.
• Indicator 3.7.1: Proportion of women of reproductive age (aged 15-49 years) who have their need for family planning satisfied with modern methods.
• Indicator 3.7.2: Adolescent birth rate (aged 10-14 years; aged 15-19 years) per 1,000 women in that age group.

SDG 4: Quality Education

• Target 4.7: By 2030, ensure that all learners acquire the knowledge and skills needed to promote sustainable development, including, among others, through education for sustainable development and sustainable lifestyles, human rights, gender equality, promotion of a culture of peace and non-violence, global citizenship, and appreciation of cultural diversity and of culture’s contribution to sustainable development.
• Indicator 4.7.1: Extent to which (i) global citizenship education and (ii) education for sustainable development are mainstreamed in (a) national education policies; (b) curricula; (c) teacher education; and (d) student assessment.

SDG 5: Gender Equality

• Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Program of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences.
• Indicator 5.6.1: Proportion of women aged 15-49 years who make their own informed decisions regarding sexual relations, contraceptive use, and reproductive health care.

SDG 10: Reduced Inequalities

• Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws, policies, and practices and promoting appropriate legislation, policies, and action in this regard.
• Indicator 10.3.1: Proportion of population reporting having personally felt discriminated against or harassed in the previous 12 months on the basis of a ground of discrimination prohibited under international human rights law.

Analysis

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The issues highlighted in the article are connected to SDG 3 (Good Health and Well-being), SDG 4 (Quality Education), SDG 5 (Gender Equality), and SDG 10 (Reduced Inequalities).

2. What specific targets under those SDGs can be identified based on the article’s content?

Based on the article’s content, the specific targets that can be identified are:
– Target 3.7: Ensure universal access to sexual and reproductive health-care services, including for family planning.
– Target 4.7: Ensure that all learners acquire knowledge and skills needed to promote sustainable development, including education for sustainable development.
– Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights.
– Target 10.3: Ensure equal opportunity and reduce inequalities of outcome.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Yes, there are indicators mentioned or implied in the article that can be used to measure progress towards the identified targets. These include:
– Indicator 3.7.1: Proportion of women of reproductive age who have their need for family planning satisfied with modern methods.
– Indicator 3.7.2: Adolescent birth rate per 1,000 women in the age group.
– Indicator 4.7.1: Extent to which global citizenship education and education for sustainable development are mainstreamed in national education policies, curricula, teacher education, and student assessment.
– Indicator 5.6.1: Proportion of women aged 15-49 years who make their own informed decisions regarding sexual relations, contraceptive use, and reproductive health care.
– Indicator 10.3.1: Proportion of population reporting having personally felt discriminated against or harassed in the previous 12 months on the basis of a ground of discrimination prohibited under international human rights law.

Table: SDGs, Targets, and Indicators

SDGs	Targets	Indicators
SDG 3: Good Health and Well-being	Target 3.7: Ensure universal access to sexual and reproductive health-care services, including for family planning.	Indicator 3.7.1: Proportion of women of reproductive age who have their need for family planning satisfied with modern methods. Indicator 3.7.2: Adolescent birth rate per 1,000 women in the age group.
SDG 4: Quality Education	Target 4.7: Ensure that all learners acquire knowledge and skills needed to promote sustainable development, including education for sustainable development.	Indicator 4.7.1: Extent to which global citizenship education and education for sustainable development are mainstreamed in national education policies, curricula, teacher education, and student assessment.
SDG 5: Gender Equality	Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights.	Indicator 5.6.1: Proportion of women aged 15-49 years who make their own informed decisions regarding sexual relations, contraceptive use, and reproductive health care.
SDG 10: Reduced Inequalities	Target 10.3: Ensure equal opportunity and reduce inequalities of outcome.	Indicator 10.3.1: Proportion of population reporting having personally felt discriminated against or harassed in the previous 12 months on the basis of a ground of discrimination prohibited under international human rights law.

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Source: bmcpublichealth.biomedcentral.com

 

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